Inconsistencies in diabetes knowledge and support in healthcare professionals.

[MacG3]

Hi guys,

Since joining these forums I have noticed a really worrying trend that many of the members receive varying advice from either their GPs or diabetes support teams. I'm really concerned about this and as diabetes is always being mentioned in the press as either being one of the biggest killers in the country or the largest cost to the NHS.

I've also noticed a worrying trend on members mentioning that their GP clinics are accelerating cost saving initiatives aimed at diabetes patients, changing ancillary prescriptions for meters, pens, needles and strips based on cost alone ignoring how the patients feel about their current situations.

Surely with an illness such as diabetes, which requires active control from the patient, the confidence and trust in the medications and equipment should be paramount. If the patient does not actively contribute to their own treatment and control of diabetes then the long term costs will be much higher.

For certain illnesses, such as cancer, GPs are required to send the patients records to NHS England so that they can perform analysis. This enables NHS England to report on how long (either duration or number of visits) a diagnosis takes. Maybe it is time we pushed for this kind of analysis to be performed for diabetes sufferers, reporting on diagnosis and GP performance in the treatment of diabetes.

Surely the problem is big enough?

 

[Northerner]

Such a thing does indeed exist, it's called the National Audit for Diabetes:

http://www.hscic.gov.uk/nda

The problem is in implementing the changes required to ensure 'best practice' in what is an extremely large and complex situation. A lot of HCPs are simply not up to the job, the funding isn't there as it is shifted from here to there and short-term savings are the order of the day - let others worry about the future, and a lot of people, even if they got the very best care, wouldn't comply with the advice, treatment and education given

We all just need to keep spreading the word. I think things are changing to some extent: forums such as this are increasingly being viewed by enlightened HCPs as an asset rather than a liability, so more people are encouraged to seek education and peer support which can make such a difference.

 

[RachelT]

The problem is that the government doesn't care about long term costs. Sorry, i should warn you this is going to be a political rant...
From what I can see from working inside the NHS, the government wants us to save money now, not in the future. It thinks it can do this by forcing doctors and other prescribers to prescribe generic medicines and whatever can be sourced as cheaply as possible.

I went for an appointment with my DSN last week and she gave me a new meter and prescribed me another box of test strips and a box of lancets! I was astounded, because up til now getting test strips out of any GP in my local area has been like getting blood out of a stone. She even told me that they were one repeat prescription so i could get more when i need them. I'm a type two with fairly stable (but at the moment irritatingly high, hence the appointment) sugar levels, taking metformin and gliclazide. I wondered about this sudden change of attitude and she explained:

Test strips are expensive, they cost the likes of you and me between 25 and 50 pounds a pot, as evidenced by the woman at boots saying "Oooo, these are very expensive aren't they?" when I bought my own about a fortnight earlier...They cost roughly the same to the NHS. All you lovely type ones, carb counters and anyone with unstable BMs needs them, no doubt about that, but for those that do there are lots more people who won't ever open the packet. Add to that lancets, the dreaded sharps bins (she was very relieved to hear i've still got the one i was given 6 years ago) and that's quite a lot of money potentially being spent on people who won't use it. I'm pleased she judged me responsible. Although now i've got a grand total of 4 meters, two of which need batteries and re-calibrating..

If people were given better advice on when to test and how to interpret the results then the money might not go to waste. Alas, in the NHS time is money and money is something we haven't got. My hospital has already put a ban on buying replacement uniforms and stationary until April.

So my PCT (or whatever they're called now and i've forgotten) are dishing out Caresens meters and strips, because they're cheaper than One Touch Ultras.
As for sending patient records to a central office, some of ours have problems sending records to the local hospital....Besides, local NHS services have to report just about everything to somebody in the Department of Health, it's rapidly becoming a problem that medical staff are spending more time doing audits and filling in forms than attending patients.

Sorry, rant over.

 

[Northerner]

The problem is that the government doesn't care about long term costs. Sorry, i should warn you this is going to be a political rant...As for sending patient records to a central office, some of ours have problems sending records to the local hospital....Besides, local NHS services have to report just about everything to somebody in the Department of Health, it's rapidly becoming a problem that medical staff are spending more time doing audits and filling in forms than attending patients.

Sorry, rant over.

Hehe! I started a very long, largely political, rant in response to the original post, but decided to abandon it when I realised it was taking over my life and probably no-one would get past the first ten pages...😱

In essence, I agree with you - no planning past the next election, taking money from health, where there is a growing need due to a growing and ageing population, so they can cut some mythical deficit, whilst at the same time losing billions in unpaid taxes from corporations or bailing out bankers. National Insurance should pay for health and social care - when it's done that then anything left over can got to the other things. You cannot keep 'making efficiency savings' forever, especially when it leads to things becoming less and less efficient and ultimately more expensive

Regarding the argument about people getting strips on prescription then not using them, I cannot see why it can't be a requirement to provide meter readings once every 3 or 6 months to prove you are using them - if you can't prove it, they get stopped. Anyway, who are all these people who are being given strips willy nilly? The number of people I have heard here who are absolutely up for testing regularly and efficiently to help improve their quality of life, and reduce medications and complications risks, who are then refused them belies that! How can there be a huge proportion of nurses and doctors who just routinely hand out strips, and also a huge proportion who routinely do not? And those who are handing them out, why aren't they providing education and follow-ups to ensure they are being used correctly? Grrr!!! 😡

See! You've set me off on one now! 😉

 

[happydog]

Unfortunately there is a lot of truth in what has been said. I had to really struggle to get 25 strips a month and they could stop at any time as it is not my GPs policy to give them out. I took my readings with graphs to show the DN. She was not interested and I suspect could not interpret them and said I was being obsessive. When I went on a diabetes education course (not a very good one, provided locally and on the cheap), there were a lot of people there who just did not get it that they have to change their life style and I could tell that they were not going to do much about their diabetes, so it is a problem. I just wish that those of us who want to do the right thing did not have such a battle. It is so short sighted my rant over as well 🙂

 

[MacG3]

Thanks Northerner, I had a quick look but it looks like they are not going to publish the results of the audit. Hmmm I wonder why the good news is that when Care.Data goes live, even more information will be available for organisations to analyse.

Good diabetes education, outside the UK, is being driven by the private sector. In the US the medical insurance companies have now caught on to the fact that this is going to cost them money. Rather than cutting back on medications and equipment, they are proactively investing in making sure their customers are managing their lives. People suffering from diabetes are being assigned councillors whose job is to educate, encourage and cajole people into eating correctly and take exercise. Even going as far as offering free gym membership and online monitoring systems to link activity and blood sugar levels and making the information a available to the care team.

Coming soon, to several countries but not the UK, a large US organisation is looking at starting a scheme for diabetes sufferers partnering with food outlets and running something like weight watchers. Meals will be given a rating which will basically make it easier for carb counters. You enter your doses and scan the menu and it will recommend a dose for the meal. They are looking to sell this to insurance companies. Ironically the system for this is being developed in the UK, I only found it mildly interesting until I was diagnosed 😉

 

[KookyCat]

I've written this three times and had to stop because there was steam coming out of my ears. I believe wholeheartedly in the NHS, and I'm all for the best use of resources but this business of not offering people with type 2 on oral medication or diet control test strips, and trying to restrict the number of test strips for insulin users really annoys me. I would want control regardless of what type of diabetes I had, it's a core part of my make up, I will get the best level of control possible. It's short termism in the extreme. So here's an idea, let's stop using words like non-compliance, let's stop treating people like they are children without the ability to make informed decisions. You can no more force a person to take control than you could force them to relinquish it. Let's stop implying control means obsession, I for one am more than capable of distinguishing when I'm obsessed I don't need anyone else inferring that on my behalf when they don't know me from Eve. Let's stop implying that all people with type 2 have to do is lose weight and exercise because it's not a one size fits all approach. Novel I know but how about patient centred is actually patient centred. Ask the patient, yep, ask them what type of control they're happy and comfortable with. Those who don't want to test and want to be directed, well let them, that's what they're comfortable with. Those who want to self manage? Help them, an approach which will most likely save money in the future. How many documentaries, news items, articles do you see about how much cancer sufferers cost the NHS? How about people with a disability? People with other autoimmune? How much it would cost to support children with autism in schools? Implicit in all of this is a judgement about Diabetes, one that isn't just rife in the media, it's there for everyone to see in the medical community. Educating people about how to avoid diabetes is great, but not at the expense of those of us who have it.

 

[happydog]

Well said Kooky Cat. 🙂

 

[MacG3]

Kooky, I agree 100%.

I think that one of the problems is that after the success of the anti smoking campaign the special interest groups have now got their sights set on "fat" people and are using diabetes as ammunition in their press salvos.

There is no doubt that there is a link between inactivity and diet in type 2 diabetes but it doesn't mean everyone with diabetes is a 'porky slob'.

Patient centric care plans are the only way forward and this can only be achieved by education, both of healthcare professionals and diabetes suffers. Support should be given to everyone, tailored to their requirements and commitment.

In an ideal world the NHS accountants would lift their heads out of their spreadsheets for long enough to see this, but alas we do not live in an ideal world. For long term plans, the answer is probably going to come from the private sector, where they will either make increased profits or reduce costs. Look at the blood sugar meter market, the answer isn't who has got the best meter, but who can offer ancillary services, I can connect mine to my PC and download my sugar history to share with my DSN.

In Catalonia they are trialling a system where, as a patient, you load your bs levels, activity and food logs on a daily basis. If there is a problem your DSN is alerted and will call you to discuss.

 

[Northerner]

...There is no doubt that there is a link between inactivity and diet in type 2 diabetes but it doesn't mean everyone with diabetes is a 'porky slob'....

https://au.news.yahoo.com/thewest/a/24822502/hidden-gene-clue-to-diabetes/

"Firstly, we need to stop oversimplifying type 2 diabetes as a condition caused by excessive weight and a sedentary lifestyle, because there are many genetic factors that predispose people to diabetes," he said.

 

[PattiEvans]

Test strips are expensive, they cost the likes of you and me between 25 and 50 pounds a pot, as evidenced by the woman at boots saying "Oooo, these are very expensive aren't they?" when I bought my own about a fortnight earlier...They cost roughly the same to the NHS.

Bit late to this, but indeed they can cost individuals that sort of price over the counter - but if you must buy them over the counter then you should not be paying the VAT as a diabetic, so you should mention that when buying them and have it deducted. However, even as individuals we can buy direct from the manufacturers at between £7.50 and £15 per 50 (dependant on manufacturer).

The prices the NHS pays are as follows (direct copy from the British National Formula latest issue)

Meters and test strips
Meter (all Prescription-only medicines) Type of monitoring Compatible
test strips Test strip
net price Sensitivity range (mmol/litre) Manufacturer
Accu-Chek® Active(1) Blood glucose Active® 50-strip pack = £9.95 0.6–33.3 Roche Diagnostics
Accu-Chek® Advantage(1) Blood glucose Advantage Plus® 50-strip pack = £16.02 0.6–33.3 Roche Diagnostics
Accu-Chek® Aviva Blood glucose Aviva® 50-strip pack = £15.72 0.6–33.3 Roche Diagnostics
Accu-Chek® Aviva Expert Blood glucose Aviva® 50-strip pack = £15.72 0.6–33.3 Roche Diagnostics
Accu-Chek® Compact Plus(1) Blood glucose Compact® 3 × 17-strip pack = £16.15 0.6–33.3 Roche Diagnostics
Accu-Chek® Mobile Blood glucose Mobile® 100 tests = £31.90 0.3–33.3 Roche Diagnostics
Accu-Chek® Aviva Nano Blood glucose Aviva® 50-strip pack = £15.59 0.6–33.3 Roche Diagnostics
BGStar®(2) Blood glucose BGStar® 50-strip pack = £14.73 1.1–33.3 Sanofi
Breeze 2® Blood glucose Breeze 2® 5 × 10-disc pack = £14.87 0.6–33.3 Bayer Diabetes Care
CareSens N®(2) Blood glucose CareSens N® 50-strip pack = £12.75 1.1–33.3 Spirit Healthcare
Contour® Blood glucose Contour®

Formerly Ascensia® Microfill
50-strip pack = £15.11 0.6–33.3 Bayer Diabetes Care
Contour® XT Blood glucose Contour® Next 50-strip pack = £15.04 0.6–33.3 Bayer Diabetes Care
Element® Blood glucose Element® 50-strip pack = £9.89 0.55–33.3 Neon Diagnostics
FreeStyle®(1) Blood glucose FreeStyle® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle Freedom®(1) Blood glucose FreeStyle® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle Freedom Lite® Blood glucose FreeStyle Lite® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle InsuLinx® Blood glucose FreeStyle Lite® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle Lite® Blood glucose FreeStyle Lite® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle Mini®(1) Blood glucose FreeStyle® 50-strip pack = £15.60 1.1–27.8 Abbott
FreeStyle Optium® Blood glucose FreeStyle Optium® 50-strip pack = £15.50 1.1–27.8 Abbott
Blood ketones FreeStyle Optium® β-ketone 10-strip pack = £20.86 0–8.0 Abbott
FreeStyle Optium Neo® Blood glucose FreeStyle Optium® 50-strip pack = £15.50 1.1–27.8 Abbott
Blood ketones FreeStyle Optium® β-ketone 10-strip pack = £20.86 0–8.0 Abbott
GlucoDock® module (for use with iPhone®, iPod touch®, and iPad®) Blood glucose GlucoDock® 50-strip pack = £14.90 1.1–33.3 Medisana
GlucoLab® Blood glucose GlucoLab® 50-strip pack = £9.89 0.55–33.3 Neon Diagnostics
GlucoMen® Glycó(1) Blood glucose GlucoMen® 50-strip pack = £14.59 1.1–33.3 Menarini Diagnostics
GlucoMen® GM Blood glucose GlucoMen GM® 50-strip pack = £9.95 0.6–33.3 Menarini Diagnostics
GlucoMen® LX Blood glucose GlucoMen® LX Sensor 50-strip pack = £15.52 1.1–33.3 Menarini Diagnostics
GlucoMen® LX Plus Blood glucose GlucoMen® LX Sensor 50-strip pack = £15.52 1.1–33.3 Menarini Diagnostics
Blood ketones GlucoMen® LX Ketone 10-strip pack = £20.75 0–0.8 Menarini Diagnostics
GlucoMen® PC(1) Blood glucose GlucoMen® 50-strip pack = £14.59 1.1–33.3 Menarini Diagnostics
GlucoMen® Visio Blood glucose GlucoMen® Visio Sensor 50-strip pack = £15.50 1.1–33.3 Menarini Diagnostics
GlucoRx®(2) Blood glucose GlucoRx® 50-strip pack = £9.45 1.1–33.3 GlucoRx
GlucoRx Nexus®(2) Blood glucose GlucoRx Nexus® 50-strip pack = £9.95 1.1–33.3 GlucoRx
Glucotrend®(1) Blood glucose Active® 50-strip pack = £9.95 0.6–33.3 Roche Diagnostics
iBGStar® Blood glucose BGStar® 50-strip pack = £14.73 1.1–33.3 Sanofi
IME-DC® Blood glucose IME-DC® 50-strip pack = £14.10 1.1–33.3 Arctic Medical
Mendor Discreet® Blood glucose Mendor Discreet® 50-strip pack = £14.75 1.1–33.3 Merck Serono
Microdot®+(2) Blood glucose Microdot®+ 50-strip pack = £9.99 1.1–29.2 Cambridge Sensors
MyGlucoHealth® Blood glucose MyGlucoHealth® 50-strip pack = £15.50 0.6–33.3 Entra Health
Omnitest® 3 Blood glucose Omnitest® 3 50-strip pack = £9.89 0.6–33.3 B. Braun
One Touch Ultra®(1) Blood glucose One Touch Ultra® 50-strip pack = £11.99 1.1–33.3 LifeScan
One Touch Ultra 2®(2) Blood glucose One Touch Ultra® 50-strip pack = £11.99 1.1–33.3 LifeScan
One Touch UltraEasy®(2) Blood glucose One Touch Ultra® 50-strip pack = £11.99 1.1–33.3 LifeScan
One Touch UltraSmart®(2) Blood glucose One Touch Ultra® 50-strip pack = £11.99 1.1–33.3 LifeScan
One Touch® VerioPro(2) Blood glucose One Touch® Verio 50-strip pack = £14.99 1.1–33.3 LifeScan
One Touch® Vita(2) Blood glucose One Touch® Vita 50-strip pack = £15.07 1.1–33.3 LifeScan
SD CodeFree® Blood glucose SD CodeFree® 50-strip pack = £6.99 0.6–33.3 SD Biosensor
Sensocard Plus®(1) Blood glucose Sensocard® 50-strip pack= £16.30 1.1–33.3 BBI Healthcare
SuperCheck2®(2) Blood glucose SuperCheck2® 50-strip pack = £8.49 1.1–33.3 Apollo Medical
TRUEone® Blood glucose All-in-one test strips and meter 50-strip pack with meter = £14.99 1.1–33.3 Nipro Diagnostics
TRUEresult®(2) Blood glucose TRUEresult® 50-strip pack = £14.99 1.1–33.3 Nipro Diagnostics
TRUEresult twist®(2) Blood glucose TRUEresult® 50-strip pack = £14.99 1.1–33.3 Nipro Diagnostics
TRUEtrack® Blood glucose TRUEtrack® 50-strip pack = £14.99 1.1–33.3 Nipro Diagnostics
TRUEyou mini® Blood glucose TRUEyou® 50-strip pack = £9.92 1.1–33.3 Nipro Diagnostics
WaveSense JAZZ®(2) Blood glucose WaveSense JAZZ® 50-strip pack = £9.87 1.1–33.3 AgaMatrix

Sorry, that's a bit long winded, but I think it could be important that you know what the NHS is paying in order to enable you to choose a meter which has less costly strips and therefore give you more of a chance to persuade your GP to prescribe them. I regret to say mine are amongst the higher price end (Accu-Chek Aviva) but I have no choice as my meter is an integral part of my pump.